9723 NE 2 Ave (9)Date
Type Insp'n
Permit No.
Name
Address ,91q-
Company
Phone #
For Inspector:
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
3
Name to
BUILDING ]Na .'?ON DEPARTMENT
APPLICATION ' < -. ti BUILDING PERMIT
Application is hereby evade for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in comolianc, and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during pr ogress of the work.
Date... _ 0! l
Owner's Name and Address . le—kill- - E J Fie /e /f (ee
fe EilaT � 1 0
Registered Architect and /or Engineer.. _
Name and address of licenses contractor
Location and legal description of lot to be built on:
Lo. Block C Street and Number where work is to be done e /� ___. C 9
State work tube done and purpo of building (by floors)._ _
- 42
and for no other purpose.
New Building . Remodeling _ - _ Addition._ _.- - ____ Repairs... - -.. .. - -_. -• -_ No. of Stories
To be constructed of __ Kind of foe atio ;x 1 __ _ ___ Roof Covering
�C p
Estimated Total cost of improvements $ .. .. _ - Amount of Permit $
Zone cubage required _Plan Cubage__
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
II hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to -- _ - - - .- - - -.__ __ --
permit, as are licensed by Miami Shores Village.
Remarks
STATE OF FLORIDA, p
COUNTY OF DADE. j ss
Chairman
Member _
Member
MIAMI S'1 ?ES VILLAGE
Subdivision.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the rovisions thereof, and will ret siznilar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such 4 uik...: .r , on work to be per reed under this
lIrr
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the .
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him tel are trueer'
Permit No
Date. .) ---- ��
__ _
Disapproved : (Signed)
Building
Building Inspector / My Commission Expires
PLANNINGlBDARD
(Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
DATE
Member _
Member
Member .
IgC
Street____ __.. '
to me well known,
Council Approved . ___. __ Date Disapproved Date
NOTE: A charge of $1.00 will be made for making correrions or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when sr.-11 re- .nspection is made necessary by improper nonce for inspection or faulty
materials and /or workmanship.